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Mail Form To:  Congregation Beth El     109 East Avenue     Norwalk, CT     06851 

DONOR NAME(S): ____________________________________________________________

DONOR ADDRESS: ____________________________________________________________

DONOR TELEPHONE NUMBER: ___________________________________________________

GIFT IS MADE:    □ IN HONOR OF  ___________________________________________(NAME)

                        □ IN MEMORY OF ___________________________________________(NAME)

                        □ ON THE OCCASION OF ___________________________________________

SEND ACKNOWLEDGEMENT TO:   NAME(S)____________________________________________________

ADDRESS________________________________________________________________________________

NOTE: $18 minimum contribution for a mailed acknowledgement.  All contributions are recognized in the Bulletin

GIFT IS MADE TO THE ___________________________________________________________FUND.               Contributions will be placed in the General Operating Fund unless otherwise specified. Please see separate full listing of funds.

I AM ENCLOSING A CHECK FOR $________________________OR PLEASE CHARGE MY CREDIT CARD

NAME AS IT APPEARS ON CREDIT CARD_____________________________________________

CREDIT CARD NUMBER____________________________________ EXPIRATION DATE:_______